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Additional info for Problem-Based Approach to Gastroenterology and Hepatology

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Furthermore, in NCCP patients who underwent simultaneous esophageal manometry and pH testing, chest pain was more commonly associated with acid reﬂux events than motility abnormalities [58,59]. Studies have shown that chest pain will often improve without any normalization of the esophageal motor abnormalities. Unlike GERD, in which PPIs are generally highly effective in alleviating symptoms, we are still devoid of pharmacological agents that can effectively treat esophageal dysmotility. The latter further complicates our ability to determine any relationship between chest pain and manometric ﬁndings.

When the balloon was inﬂated to 10 mL, patients with a history of NCCP were more likely to experience pain (18 of 30) than the control individuals (6 of 30). Barish et al. evaluated 50 patients with NCCP and 30 healthy volunteers using a graded balloon distension protocol [65]. Of the patients with NCCP, 56% experienced their “typical” chest pain during balloon distension compared with 20% of control individuals. Of those with NCCP who experienced pain, 86% reported it at volumes less than 8 mL while all normal volunteers experienced pain with 9 mL or greater.